ACUTE RIGHT-VENTRICULAR FAILURE DURING AORTIC VALVULAR OPERATION DUE TO MECHANICAL PROBLEM IN THE RIGHT CORONARY-ARTERY

Background. When right ventricular failure occurs during aortic valvul ar operation, inadequate myocardial protection may be the culprit. How ever, other causes of right ventricular failure should be considered, such as air or particulate matter embolization. Right ventricular fail ure unexpectedly occurred during an aortic valvular operation, and the cause was found to be a mechanical problem with the right coronary os tium. Methods. A mechanical problem with the right coronary artery (RC A) occurred in 9 patients undergoing aortic valvular procedures, which included isolated aortic valve replacement (4 patients), aortic valve replacement and coronary artery bypass (1 patient), Bentall procedure (2 patients), aortic valve reconstruction (1 patient), and double val ve replacement and coronary artery bypass (1 patient). Although myocar dial protection was considered to be the cause, a mechanical problem w as subsequently identified in the RCA, leading that artery to be bypas sed with a segment of saphenous vein. Results. The 1 patient in whom t he condition was not recognized at time of aortic Valve operation died ; at autopsy, a damaged and occluded right ostium was confirmed. The o ther 8 patients who had the RCA bypassed survived. Conclusions. We con clude that when right ventricular failure unexpectedly occurs during a n aortic valvular operation and does not improve with reperfusion, a m echanical problem in the RCA should be considered. In this situation r ye recommend that the RCA be bypassed with a segment of saphenous vein graft.